The great myth of toxic shock

Remember the great tampon scare of the 1980s? It vanished, and here's why, writes Bettina Arndt.

Whatever happened to toxic shock? This huge health scare dominated news in the early 1980s but now has virtually disappeared. For two decades women were warned about a possible link between tampon usage and the potentially fatal bacterial disease known as toxic shock syndrome. Now the issue seems dead in the water.

"We haven't seen a case for years. It seems to have disappeared," says Professor Richard Benn, head of the Department of Microbiology and Infectious Diseases at Royal Prince Alfred Hospital in Sydney, and a member of Australia's expert panel on toxic shock syndrome. The specialists do see rare cases of toxic shock in patients with surgical wounds, trauma or burns, but toxic shock associated with tampon usage is simply not being reported.

Even at the height of the drama there were very few proven cases of toxic shock linked to tampon usage. Most of the cases that attracted publicity, such as the death of a teenage girl in a swimming pool in Mount Isa, turned out to be due to other causes.

But the toxic shock scare has changed the behaviour of Australian women. Since the 1980s, the number of women using tampons as their sole means of sanitary protection has dropped substantially. Earlier figures are not available, but data gathered this decade by the leading Australian distributor, Johnson & Johnson, show that more than one-third of women exclusively used tampons in 1993, but only 22 per cent did so last year.

More and more women seem to be heeding the advice of the manufacturer and using pads for night-time use: the percentage using pads has gone up from 59 per cent in 1993 to 73 per cent last year. It is unclear how many of the 700,000 Australian women who have made this change have been influenced by the toxic shock scare into sacrificing the convenience and comfort of tampons overnight. (There are women who simply prefer pads, particularly the streamlined newer models).

But Johnson & Johnson's figures also show that every month more than 1.5 million Australian women are ignoring the scare and using tampons overnight. And they are not getting toxic shock. That's because the risk is, and always has been, miniscule, says Dr Terri Foran, medical director of the New South Wales family planning body, FPA Health. "You are more likely to be run over by a bus than get toxic shock through tampon usage," she says.

The advice given by manufacturers - to change tampons every two to three hours, and never use them overnight - is overkill, crazy caution prompted by the threat of vengeful litigants and greedy lawyers.

Who better to challenge this cautious approach than our leading female medical specialists? Last week I called a dozen prominent Australian female professors of medicine and asked them about their own menstrual habits. Eleven of the 12 had made no change to their pattern of tampon usage following the toxic shock scare and had continued to use tampons overnight.

But a number reported battles with teenage daughters who were certain that the manufacturers' advice must be taken as gospel, despite what their knowledgeable mothers had to tell them. The girls receive the same cautious advice in women's magazines and sex education lessons. No one dares publicly to tell them to be sceptical.

So they take the risk of toxic shock seriously - far too seriously. The tiny risk of what is now a well-diagnosed and treatable disease doesn't compare to the many risks these girls don't think twice about, such as baking themselves in the sun, smoking, binge drinking, experimenting with drugs, travelling in cars driven by drunken boyfriends or forgetting the condom.

We all need to learn to properly assess and live with risk, otherwise we are the ones who suffer. In 1995, the British government removed from the market all of the new "third generation" contraceptive pills, after an outcry over an alleged link to thrombosis. As a result, there was a documented increase in unplanned pregnancy and abortion during the year these pills were unavailable. The irony is that on average, the risk of thrombosis during pregnancy is twice that associated with these pills.

Similarly, only 1.5 per cent of Australian women using contraceptives have an intrauterine device (IUD) - despite the fact that for many women, the latest of these devices are among the safest and most effective options now available. In the past, there were medical risks for some women with some of these devices, but the mistrust of the newer devices makes no sense.

Unless people are prepared to act responsibly and accept risk - instead of threatening to sue if something does go wrong - who will ever dare speak out and provide us with accurate, rational advice? We will continue to be treated like children, limiting our options by having decisions made for us.